DIET

Infants
should not receive anything except breast milk, formula, water or rice cereal
until 4 months of age. Rice cereal may be given at this age, but not oatmeal,
rye or barley cereals. Remember feeding other foods too early could lead to
allergies. At the next check up, you will receive a teaching sheet just like
this one that covers how to start your baby on fruits and vegetables. A little
diluted fruit juice (non-citrus) may be used for constipation, but do not give
very much. If you give full strength fruit juice, then your baby could get
diarrhea. If you give too much juice (more than a few ounces per day), then this
could suppress your babyís appetite for formula or breast milk, and could lead
to failure to gain weight adequately. Also, make sure that the juice is
pasteurized as many infants have become sick from non-pasteurized juice.

BREAST
FED INFANTS: All infants should receive 200-400 micrograms of Vitamin D.
Vitamin D is essentially for Calcium metabolism and bone strength. Infants who
are Vitamin D deficient can get Rickets (severe weakness of the bones). Breast
milk does not contain Vitamin D. 12 ounces of formula contains the minimum
requirement of Vitamin D (200 micrograms). If you are supplementing with more
than 12 ounces of formula per day, then no additional vitamins are necessary for
the baby. If you are exclusively breast-feeding or giving less than 12 ounces of
formula, the buy TRI-VI-SOL vitamins (over the counter) and give the amount
recommended on the bottle for your infants age.

COMMON
ILLNESSES & PROBLEMS

The most common question at this age is still about nasal congestion.
Please refer to your newborn booklet for how to handle this and how to tell it
from a cold. The newborn booklet does cover what signs to watch for. The
difference between a cold and nasal congestion actually doesnít matter much,
since we treat them the same. I never recommend cold medicines until 8 years of
age since there is no scientific evidence that they do any good at all, and
roughly 100,000 children end up in the emergency room because of cold medicine
side effects every year. Cold medicines that have antihistamines do help
allergies, which many people confuse with colds. Thankfully, most children will
not show signs of allergies until 6 months of age. The next most common question
is about getting you baby to sleep through the night; this again is covered in
detail in your newborn booklet. Many parents also ask about teething.Children can teeth at a very early age, but most will not cut a tooth
until 5 to 10 months. I see many children cut teeth at 3 months, and almost
always one of their parents did the same thing. Teething will resemble ear
infections in that both can give fevers up to 102, increased nasal mucus,
pulling on the ears. Teething will have EPISODIC fussiness and
will often be accompanied by loose stool. Ear infections will have
continuous fussiness that worsens to the point of requiring a trip to
the doctor. If you suspect that your child has an ear infection, and the pain is
bad, then call anytime for what to do. If the pain is mild to moderate, give
your child Tylenol or Motrin for pain (see newborn booklet for dosing), put a
heating pad on the ear, and call the office during business hours for what to
do. For teething, give Ambisol, Oragel or Numzit as directed along with Motrin
for the pain.

SAFETY

If you havenít already, please crawl around your house, and look for
anything that can hurt your baby. The newborn booklet contains a good start for
what to look for:

Water heater should be set at 120 degrees F

All electrical outlets should have safety plug

All poisons should be locked up

All small objects should be out of babyís reach

Fire extinguishers should be in strategic locations

Guns should be secured

Bedclothes should be fire retardant

Hand me downs should be double checked for safety

Window blind cords should not be able to hang your
baby

Walkers should never be used

Gates should secure stairs

Many parents buy walkers about this time, or accept
one from a friend or relative. When the walker supports your child, the muscles
that move the leg side to side are not needed.This actually causes a delay in walking by an average of 3 weeks. Walkers
also cause about 3-500 deaths and 30,000 emergency room visits per year, mainly
due to a child going through a locked gate, down a flight of stairs, or by
pulling something onto them. The stationary walkers are a better alternative for
safety reasons, but still delay walking. If you use any of these devices, please
make sure to watch the baby very closely and NOT USE THE WALKER AS A BABY
SITTER. Even though I give this message to everyone, I still see walker
injuries. I remember one incident very well where I was giving this message to a
family during a well child check up and was called out of the room, not once,
but twice, during that exam because 2 children had been injured by a walker.

NEXT VISIT

The next check up will be a 4
months of age. At that visit, your child should get exactly the same vaccines
as they did today. We will also cover how to start fruits and vegetables,
but they should not be started below 3.5 months of age as this might cause
allergies. For premature babies, we do not give these foods until the child
would have been 3.5-4 months if they were born on time (3.5-4 months from the
original due date).